, Eun Mi Chun, Jihyun Lee, Yookyung Kim, Sun Hee Sung, Yun Hwan Kim Extrapulmonary tuberculosis usually involves the pleura, central nervous system, lymphatic system, genitourinary system and bone with joint. There are few reports about pulmonary tuberculosis involving the endometrium and muscle. A 32-year-old woman who had intact immunity visited hospital due to menorrhagia, and was diagnosed with endometrial tuberculosis. The patient also had a painless abdominal mass about for 1 year before she came to the hospital. She was diagnosed with rectus abdominis muscle tuberculosis, endometrial tuberculosis, and pulmonary tuberculosis at the same time. We report a case of endometrial tuberculosis accompanied with rectus abdominis muscle and pulmonary tuberculosis in a non-immunosuppressed person.
, Jin Hwa Lee, Sun Hee Sung, Seong Hoon Park Amiodarone has been widely used for supraventricular and ventricular arrhythmias and many patients benefit from its effectiveness in treating potentially life-threatening arrhythmias. However, this drug can cause multi-organ toxicity, including amiodarone-induced pulmonary toxicity (APT). Not only does amiodarone have a long half-life but also is lipophilic and therefore can easily accumulate in tissues. Hence, it is difficult to monitor therapeutic levels and side effects, making it difficult to predict toxicities. In this case, we describe multi-organ complications secondary to amiodarone use, especially APT combined with pneumonia with atypical pathogens and pulmonary hemorrhage. The patient reached a high cumulative dose of amiodarone despite a low maintenance dose of amiodarone. This case highlights an unusual presentation of APT with multi-organ toxicity and we review articles regarding the association between the cumulative dose of amiodarone and amiodarone-induced toxicities.
Citations
, Sun Hee Sung, Ryung-Ah Lee Desmoid tumor is rare neoplasm originated from fibrous sheath or musculoaponeurotic structure. It is classified as benign tumor histologically, but clinically, it has malignant characteristics due to its infiltrative growth to adjacent organ and frequent local recurrence. Especially, mesenteric desmoid tumor shows poor prognosis because of its symptoms of pain, intestinal obstruction, ureter obstruction and fistula formation and high frequency of recurrence. We experienced a case of mesenteric desmoid tumor in a 64-year-old woman with a painless abdominal mass. Laparoscopic exploration was performed and 10 cm sized mesenteric mass was identified, which resected widely and the diagnosis was confirmed with desmoid tumor by pathologic report. We reviewed the feature of the mesenteric desmoid tumor, that is, pathophysiology, clinical presentations, diagnosis, treatment and prognosis.
, In Jeong Cho, Seung Hyun Yoo, Mina Yu, Dong Ryeol Ryu, Seung Jung Kim, Duk Hee Kang, Kyu Bok Choi, Kyun Il Yoon, Sun Hee Sung A unique type of rapidly progressive interstitial fibrosis of the kidney, the Chinese Herb Nephropathy (CHN) has been reported in Belgian woman after intake of Chinese herbs. CHN contains several characteristics that include variable clinical features from progressive renal failure to Fanconi's syndrome, histologic finding of extensive interstitial fibrosis, high risk of urothelial malignancy. We are reporting a case of33 year-old female patient who was diagnosed as CHN. The patient visited our hospital with symptoms of nausea. Laboratory investigation showed metabolic acidosis with normal anion gap, hypokalemia, hypophosphatemia, proteinuria, glycosuria consistent with Fanconi's syndrome. She took Chinese herbs for slimming 4 months before. Renal biopsy showed the features of tubular cell injury with interstitial edema, accompanied by interstitial fibrosis on following biopsy, compatible with Chinese Herb Nephropathy. After 5 months, her renal function was progressed rapidly, therefore peritoneal dialysis was started. This case shows that we should consider Chinese herb as a cause of renal failure.
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, Hye Jung Chang, Min Jung Kang, Ji Young Oh, In Je Kim, Yun Su Sim, Jin Wook Moon, Jung Hyun Chang, Jin Hwa Lee, Sun Hee Sung Acute eosinophilic pneumonia is characterized by acute febrile disease with diffuse interstitial infiltration on chest radiography, eosinophilic infiltration of lung parenchyma on lung biopsy and good response at corticosteroid therapy. There has been several reports that support cigarette smoking recently, even though the pathogenesis is not clear. We encountered a case of acute eosinophilic pneumonia induced by cigarette smoking, who, being a 20-year-old man, presented with acute onset of fever after his first cigarette smoking. His clinical symptoms and the infiltrations on onset x-ray improved after a treatment with corticosteroid.
, Min A Yu, Young Sook Lee, Mi Yoen Kim, Seung Jeong Kim, Duck Hee Kang, Gyeon Il Yun, Kyu Bok Choi, Sun Hee Sung Dense deposit disease (DDD), known as type II MPGN, is an uncommon form of glomerulonephritis. It is an acquired primary glomerular disease, characterised by electron microscopic evidence of a continous, dense membrane deposition replacing the lamina densa. There is associated alternative pathway complement activation and a C3 nephritic factor maybe present. Patients with dense deposit disease tend to be young at clincal onset and more commonly have persistent nephrotic syndrome, gross hematuria, and acute nephritis episode and persistent depression of the serum complement level. The prognosis of dense deposit disease is worse than that of type I MPGN. We experienced a patient with dense deposit disease that presenting persistent nephrotic syndrome, gross hematuria and having subepithelial hump. It is a first report of dense deposit disease having subepithelial hump in Korea, therefore we report this case with the review of relevant literatures.
, Hye-Young Choi, Chung Sik Rhee, Sun Hee Sung To evaluate pathologic findings of fibrocystic disease correlated with sonographic findings in the patients with solid lesion on ultrasonography.
Total 63 pathologically proven fibrocystic disease in 57 patients are retrospectively evaluated. On ultrasonography, the lesions were divided into solid and non-solid mass-like lesions. We analyzed the margin and echogenicity of solid mass-like lesions that were correlated with pathologic findings and also statistically analyzed Chi-square and Fisher's exact test.
Ultrasonogram of fibrocystic disease showed solid mass-like lesion in 73% and non solid mass-like lesion in 27%. Among the solid lesions, well-defined margin revealed in 72%, ill-defined margin in 28% and hypoechoic in 59%, isoechoic 41%. On the pathologic analysis, the solid and the non-solid mass-like lesion showed respectively : fibrous stroma in 56.5% and 53%, fibroadenomatous change in 50% and 12%, mixed stroma in 41% and 35.3%, cystic change in 37% and 70.6%, ductectasia in 28% and 58.8%, lobular hyperplasia in 26% and 12%, ductal hyperplasia 13% and 5.9%, and adenosis in 8.7% and 0%. The solid lesions showed more fibroadenomatous change and the difference between there was statistically significant(p=0.008).
The solid mass-like lesion, which represented as a well-defined isoechoic benign mass on ultrasonogram was more common than as expected, and this was due to the fibroadenomaous change on histopathology.
, You Kyoung Cho, Hyun Ju Song, Hyun Kyung Lee, Jin Hwa Lee, Sun Hee Sung, Yoo-kyung Kim, Jung Hyun Chang Primary ciliary dyskinesia is a genetic disorder of abnormal ciliary structure and function that leads to defective mucociliary clearance, resulting in sinopulmonary infection and infertility. Kartagener's syndrome is a subclass of primary ciliary dyskinesia and which is clinically distinguishable by the presence of situs inversus. Electron microscopy of cilia reveals ultrastructural defects in the ciliary axoneme. In the respiratory tract, this inability presumably causes impaired clearance of mucus and inhaled particles and results in the chronic infections of sinuses and bronchial trees that are characterized of the disease. Early diagnosis of the disease may be important for prevention of bronchiectasis and pulmonary insufficiency.
We report one case of primary ciliary dyskinesia associated with Kartagener's syndrome in a 14 year-old young man who was presented as bronchiectasis, chronic and situs inversus, with review of literature.
, Sun Hee Sung, Hea Soo Koo, Woon Sup Han, Ok Kyong Kim Gastric polyp is histologically very diverse and its classification is still unsettled. The purpose of the article is to classify the endoscopically diagnosed polypoid lesions and to evaluate their malignant potential.
A retrospective study was done on 142 cases of endoscopically diagnosed gastric polypoid lesions from September 1993 to May 1996. We investigated their clinical findings, histopathology, and nuclear gradings of PCNA by immunohistochemistry.
1) The mean age is 57.9 and sex ratio os 0.8:1
2) The most prevalent location is antrum(57.7%).
3) Morphologically, Yamada type II is the most frequent(35.9%).
4) Histologically, lesions are classified as true polyps and reactive lesions. True polyps are subclassified as hyperplastic polyp(61.2%), adenomatous polyp(19.4%), mixed adenomatous and hyperplastic polyp(10.2%), fundic gland polyp(2.0%), and adenocarcinoma(7.1%). Reactive lesions are subclassified as chronic superficial gastritis(68.2%), mucosal hyperplasia(15.9%), edema of lamina propria(9.1%), xanthoma(4.5%), and ectopic pancreas(2.3%).
5) Atypical changes is accompanied in 12 cases(20%) of hyperplastic polyps.
6) Adenocarcinoma arising from adenomatous polyp is noted in 6 cases. In hyperplastic polyp one case is combined with adenocarcinoma.
7) Among the true polyps single lesions are 127 cases(89.4%), and multiple lesions, 15 cases(10.6%)
8) Immunohistochemical staining for proliferating cell nuclear antigen(PCNA) reveals that hyperplastic polyps show focal positive rection in the area of pit and fundus, and adenomatous polyps show diffuse positive reaction. Dysplastic foci in both adenomatous and hyperplastic polyps shows diffuse positive reaction of PCNA.
Endoscopically diagnosed polypoid lesions show variable histologic findings ranging from chronic superficial gastritis to adenocarcinoma. They are mainly subclassified as histologically true polyps and reactive lesions. Some of true polyps have atypical changes of varing dgree in not only adenomatous polyps but also hyperplastic polyps.
Endometrial hyperplasia(EH) and endometrial carcinoma(EC) very in their biologic potential, which may be correlated with the histologic grade. Evaluation of cellular kinetics, which may prove to be another measure of predicting biologic behavior. Accessments of AgNORs and PCNA(proliferative cell nuclear antigen) indeces in 33 cases of EH including 16 cases of simple hyperplasia(SH), 8 of complex hyperplasia(CH), and 9 of atypical hyperplasia(AH), and 28 of EC including 7 of grade I, 12 of grade II, and 6 of grade III were performed. The results were as follows :I, 12 of grade II, and 6 of grade III were performed. The results were as follows : 1. AgNOR counts per glandular cells(Mean SD) were 2.7±0.2 in normal proliferative and 2.3±0.2 in secretory endometrium, and increased to 3.2±0.3 in SH, 3.5±0.3 in CH, to 5.4±0.4 in AH, and finally 6.9±0.5 in endometrioid carcinoma(grade I: 5.8±0.7, grade II: 6.7±0.6, grade III: 8.4±0.9). 2. PCNA indeces(percentages of nuclear positive cells of total cells of glands) were 16±14.2 in normal proliferative endometrium and 12±8.1 in secretory endometrium, and increased to 18.4±14.7 in SH, 21.6±17.8 in CH, 36.4±27.4 in AH, and finally 42.1±31.3 in EC(grade I: 38.3±23.2,grade II: 39.4±25.4, and grade III: 58.4±35.3). 3. DNA aneuploidy was detected in 4 cases of EC(40%), and tended to be more frequently found in poorer histologic grade. This data suggest that cell kinetic evaluation of EH and EC using AgNORs and PCNA is well correlated with histologic grade. And with the aspect of biologic potential, AH could be regarded as well differentiated EC.
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